1. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Disorders

2. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance Abuse A substance is any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors.

3. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Conditions Recognized by the DSM-IV-TR Substance intoxication: Experience of significant maladaptive behavioral and psychological symptoms due to the effect of a substance on the central nervous system. Substance withdrawal: Experience of clinical significant distress in social, occupational, or other areas of functioning due to the cessation or reduction of substance use.

4. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Conditions Recognized by the DSM-IV-TR, continued Substance abuse: Diagnosis given when recurrent substance use leads to significant harmful consequences. Substance dependence: Diagnosis given when substance use leads to physiological dependence or significant impairment or distress.

5. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Abuse One or more of the following occurs during a 12- month period, leading to significant impairment or distress: 1.Failure to fulfill important obligations at work, home, or school as a result of substance abuse. 2.Repeated use of the substance in situations in which it is physically hazardous to do so. 3.Repeated legal problems as a result of substance use. 4.Confirmed use of the substance despite repeated social or legal problems as a result of use.

6. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Dependence Maladaptive pattern of substance use, leading to three or more of the following: 1. Tolerance, as defined by either: the need for markedly increased amounts of the substance to achieve intoxication or desired effect; markedly diminished effect with continued use of the same amount. 2. Withdrawal, as manifested by either: the characteristic withdrawal syndrome for the substance; the same or closely related substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended.

7. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Dependence, continued 4. There is a persistent desire or unsuccessful efforts to cut back or control use. 5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by the substance.

8. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Problems Experienced by People Who Are Diagnosed with Alcohol Abuse or Dependence Percent saying yes

9. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Long-term Effects of Alcohol Abuse Alcohol-induced persisting amnesic disorder Wernicke’s encephalopathy Korsakoff’s psychosis Alcohol-induced dementia Fetal alcohol syndrome

10. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Benzodiazepines and Barbiturates Benzodiazepines (such as Xanax, Valium, Halcion, and Librium) and barbiturates (such as Quaalude) are legally manufactured and sold by prescription, usually for the treatment of anxiety and insomnia. Two common patterns of abuse can develop with these substances: – 1. adolescents using them for recreational purposes – 2. people (particularly women) using initially under physician’s care but then increasing doses as tolerance develops

11. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Inhalants Inhalants are solvents such as gasoline, glue, paint thinners, and spray paints. The greatest users of inhalants are young boys between 10 and 15 years of age. Chronic users may have a variety of respiratory irritations and rashes. They can also cause permanent damage to the central nervous system, and can lead to organ failure.

12. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Cocaine Symptoms include: – behavioral changes (e.g., euphoria or affective blunting; impaired judgment) – rapid heartbeat, dilation of pupils, elevated or lowered blood pressure – weight loss, nausea or vomiting – muscular weakness – slowed breathing, chest pain, confusion – seizures, coma

13. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Amphetamines Used to combat depression or fatigue or boost energy and self-confidence; also in diet drugs Cause the release of dopamine and norepinephrine and clock reuptake Symptoms of intoxication are similar to cocaine intoxication

14. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Nicotine No DSM-IV-TR diagnosis for the symptoms, but nicotine operates on both the central and peripheral nervous system Results in the release of several biochemicals that may have direct reinforcing effects on the brain, including dopamine, norepinephrine, serotonin, and the endogenous opioids

15. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Nicotine, continued Withdrawal Symptoms dysphoria or depressed mood insomnia irritability frustration or anger anxiety difficulty concentrating restlessness decreased heart rate increased appetite or weight gain

16. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Caffeine The most heavily used stimulant drug 75% of caffeine ingested through coffee The average American drinks about two cups of coffee per day; a cup of brewed coffee has about 100 milligrams of caffeine. Caffeine stimulates the central nervous system increasing levels of dopamine, norepinephrine, and serotonin

17. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Stimulants: Caffeine, continued Symptoms: Restlessness, nervousness, excitement, insomnia, flushed face, frequent urination, stomach upset, muscle twitching, rambling flow of thought or speech, rapid heartbeat, periods of inexhaustibility, psychomotor agitation Withdrawal Symptoms: Marked fatigue or drowsiness, increased appetite or weight gain, marked anxiety or depression, nausea or vomiting

18. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Opioids- derived from the opium poppy Morphine Heroin Codeine Methadone

19. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Opioids Intoxication Symptoms Behavioral changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment), drowsiness or coma, slurred speech, hallucinations/illusions, attention and memory problems Withdrawal Symptoms Dysphoric mood, nausea or vomiting, muscle aches, tearing/nasal mucus discharge, dilation of pupils, goose bumps, sweating, diarrhea, yawning, fever, insomnia

20. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Hallucinogens and PCP Hallucinogens are a mixed group of substances including LSD, MDMA (also called ecstasy), and peyote. PCP, also known as angel dust, is a manufactured as a powder to be snorted or smoked. Although not classified as a hallucinogen, it has many of the same effects.

21. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Hallucinogens and PCP, continued Intoxication Symptoms Behavioral changes (e.g., marked anxiety or depression, paranoia, belligerence), perceptual changes while awake, intensification of senses, dilation of pupils, rapid heartbeat, sweating, palpitations, blurring of vision, panic, tremors. Withdrawal Symptoms While not strictly withdrawal symptoms, some other side-effects include flashbacks and dehydration.

22. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Biological Theories Genetic Factors – Family history, adoption, and twin studies all suggest that genetics may play a substantial role in at least some forms of addiction. Alcohol Reactivity – The sons of alcoholics have a lower reactivity to moderate doses of alcohol which may lead them to drink substantially more before they begin to feel drunk. Alcoholism as a Form of Depression – As much as 70 percent of people with alcohol dependency have depressive symptoms severe enough to interfere with daily living.

23. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Behavioral and Cognitive Theories Children and adolescents learn alcohol-related behaviors from the modeling of their parents and important others in their culture. People who expect alcohol to reduce their distress and who do not have other, more adaptive means of coping available to them are more likely than others to drink alcohol when they are upset and are more likely to have social problems related to drinking.

24. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Sociocultural Approaches Chronic stress combined with an environment that supports and even promotes the use of substances as an escape is a recipe for widespread substance abuse and dependence. Substance use, particularly alcohol use, is much more acceptable for men than for women in many societies. When women do become substance abusers, their patterns of use and reasons for use tend to differ from men’s.